Hong Steven Y, Fanelli Theresa J, Jonas Anna, Gweshe Justice, Tjituka Francina, Sheehan Heidi M B, Wanke Christine, Terrin Norma, Jordan Michael R, Tang Alice M
*Division of Geographic Medicine and Infectious Diseases, Tufts Medical Center, Boston, MA; †Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA; ‡Directorate of Special Programmes, Republic of Namibia Ministry of Health and Social Services, Windhoek, Namibia; §Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA; and ‖Tufts Clinical and Translational Science Institute, Tufts University, Boston, MA.
J Acquir Immune Defic Syndr. 2014 Dec 1;67(4):e115-22. doi: 10.1097/QAI.0000000000000308.
Food insecurity is emerging as an important barrier to antiretroviral therapy (ART) adherence. The objective of this study was to determine if food insecurity is associated with poor ART adherence among HIV-positive adults in a resource-limited setting that uses the public health model of delivery.
A cross-sectional study using a 1-time questionnaire and routinely collected pharmacy data.
Participants were HIV-infected adults on ART at the public ART clinics in Windhoek, Namibia: Katutura State Hospital, Katutura Health Centre, and Windhoek Central Hospital. Food insecurity was measured by the Household Food Insecurity Access Scale (HFIAS). Adherence was assessed by the pharmacy adherence measure medication possession ratio (MPR). Multivariate regression was used to assess whether food insecurity was associated with ART adherence.
Among 390 participants, 7% were food secure, 25% were mildly or moderately food insecure and 67% were severely food insecure. In adjusted analyses, severe household food insecurity was associated with MPR <80% [odds ratio (OR), 3.84; 95% confidence interval (CI): 1.65 to 8.95]. Higher household health care spending (OR, 1.92; 95% CI, 1.02 to 3.57) and longer duration of ART (OR, 0.82; 95% CI: 0.70 to 0.97) were also associated with <80% MPR.
Severe household food insecurity is present in more than half of the HIV-positive adults attending a public ART clinic in Windhoek, Namibia and is associated with poor ART adherence as measured by MPR. Ensuring reliable access to food should be an important component of ART delivery in resource-limited settings using the public health model of care.
粮食不安全正成为抗逆转录病毒疗法（ART）依从性的一个重要障碍。本研究的目的是确定在采用公共卫生服务模式的资源有限环境中，粮食不安全是否与HIV阳性成年人的ART依从性差有关。
一项横断面研究，采用一次性问卷调查和常规收集的药房数据。
参与者为纳米比亚温得和克市公共ART诊所（卡图图拉州立医院、卡图图拉健康中心和温得和克中心医院）接受ART治疗的HIV感染成年人。粮食不安全状况通过家庭粮食不安全获取量表（HFIAS）进行衡量。依从性通过药房依从性指标药物持有率（MPR）进行评估。采用多变量回归分析来评估粮食不安全是否与ART依从性有关。
在390名参与者中，7%的人粮食安全，25%的人粮食不安全程度为轻度或中度，67%的人粮食不安全程度严重。在调整分析中，家庭粮食不安全严重程度与MPR<80%相关[比值比（OR）为3.84；95%置信区间（CI）：1.65至8.95]。家庭医疗保健支出较高（OR为1.92；95%CI为1.02至3.57）和ART治疗时间较长（OR为0.82；95%CI：0.70至0.97）也与MPR<80%相关。
纳米比亚温得和克市一家公共ART诊所中，超过一半的HIV阳性成年人存在严重的家庭粮食不安全状况，并且与通过MPR衡量的ART依从性差有关。在采用公共卫生护理模式的资源有限环境中，确保可靠的食物获取应成为ART服务的一个重要组成部分。
